Narrative expressive writing after divorce could improve cardiovascular health

May 8 2017

Journaling after divorce could improve your cardiovascular health -- but only if you do it in a way that tells a story, new University of Arizona research suggests.

The findings, to be published in the journal Psychosomatic Medicine, are based on a study of 109 separated or divorced men and women who split from their partners about three months, on average, before the start of the research.

Study participants were divided randomly into three groups. Those assigned to the traditional expressive writing group were told to write about their most deeply held feelings about their relationship and separation experience. Those in the narrative expressive writing group also were told to write about their feelings about the divorce, but within the framework of a narrative with a definite beginning, middle and end -- essentially telling the story of the end of their marriage. A third group was simply asked to write non-emotionally about their day-to-day activities during the assigned writing period.

Participants in all three groups were instructed to write in their designated style for 20 minutes a day for three consecutive days. Researchers conducted assessments of participants' physical and psychological health at baseline -- prior to their journaling -- and at two follow-up visits.

At the second follow-up visit, about eight months later, participants who had engaged in narrative expressive writing had a lower heart rate than participants in the other two groups. They also had higher heart rate variability, which refers to the variation in time between heartbeats and reflects the body's ability to adaptively respond to its environment and environmental stressors. Both lower heart rate and higher heart rate variability are generally associated with good health.

So what makes narrative expressive writing good for the heart?

"To be able to create a story in a structured way -- not just re-experience your emotions but make meaning out of them -- allows you to process those feelings in a more physiologically adaptive way," said Kyle Bourassa, the paper's lead author and a psychology doctoral student at the UA.

"The explicit instructions to create a narrative may provide a scaffolding for people who are going through this tough time," Bourassa said. "This structure can help people gain an understanding of their experience that allows them to move forward, rather than simply spinning and re-experiencing the same negative emotions over and over."

Participants in the narrative expressive writing group had lower heart rate and higher heart rate variability, relative to participants in the two other groups, across a variety of study conditions -- at their normal resting state, as well as when presented by experimenters with external stressors, such as reminders of their divorce or a stressful math task.

Relationship of Psychology, Physiology

The initial aim of the expressive writing study was to look at how journaling affects recovery from marital separation. A previous paper, authored by UA professor of psychology David Sbarra, detailed those findings, which revealed that both styles of expressive writing can actually result in more psychological distress for people who self-identify as "high ruminators" -- those who spend a lot of time brooding over the circumstances of their failed relationship.

In the current study, Bourassa set out to reanalyze the data using the markers of cardiovascular physiology, rather than participants' self-reported psychological well-being.

"Psychology and physiology don't always hang together, so you can have people who say they're not doing well in terms of their self-reported mood, while at the same time observing positive or adaptive changes in their physiology," said Bourassa, whose co-authors on the paper were UA Department of Psychology faculty members Sbarra, John Allen and Matthias Mehl.

Bourassa and his co-authors also found that participants' rumination, which played such a key role in the previous study of psychological outcomes, did not affect physiological outcomes.

The new findings add to a growing body of research on divorce and health, and have significant implications since marital separation often is linked with poor overall health outcomes.

"It's important to remember that we studied health-relevant biomarkers, not health outcomes, per se," Sbarra said. "We know that changes in heart rate and heart rate variability can affect health and even disease outcomes over time, and our study provides causal evidence that specific styles of writing can alter these physiological processes."

Although more research is needed to determine the long-term effects of narrative expressive writing, the initial findings suggest it doesn't take much to see robust benefits.

"One short intervention -- 20 minutes over three days -- translated to these measurable effects," Bourassa said. "If larger studies replicate these findings in the future, this would be an evidence-based tool that could be widely used for people struggling with divorce."